Somatom Emotion 6 Special

SOMATOM Emotion 6
Application Guide
Special Protocols
Software Version A70
The information presented in this application guide
is for illustration only and is not intended to be relied
upon by the reader for instruction as to the practice
of medicine. Any health care practitioner reading this
information is reminded that they must use their own
learning, training and expertise in dealing with their
individual patients.
This material does not substitute for that duty and is
not intended by Siemens Medical Solutions Inc., to be
used for any purpose in that regard. The drugs and
doses mentioned herein were specified to the best of
our knowledge. We assume no responsibility whats-
oever for the accuracy of this information.
Variations may prove necessary for individual patients.
The treating physician bears the sole responsibility for
all of the parameters selected.
The pertaining operating instructions must always
be strictly followed when operating the SOMATOM
Emotion 6. The statutory source for the technical data
are the corresponding data sheets.
We express our sincere gratitude to the many customers
who contributed valuable input.
Special thanks to Christiane Bredenhoeller, Christoph
S, Thomas Flohr and the CT-Application Team for their
valuable assistance.
To improve future versions of this application guide,
we would highly appreciate your questions, suggestions
and comments.
Please contact us:
USC-Hotline:
Tel. no. +49-1803-112244
email: ct-application.hotline@med.siemens.de
Editor: Ute Feuerlein
2
Overview
HeartViewCT 8
Bolus Tracking 38
Dental CT 46
Osteo CT 52
Pulmo CT 58
Perfusion CT 62
Dynamic Scanning 72
Interventional CT 74
Trauma 80
LungCARE 84
Colonography 86
Appendix 90
3
Content
HeartViewCT 8
The Basics 8
Important Anatomical Structures
of the Heart 8
Cardiac Cycle and ECG 11
Temporal Resolution 11
Technical Principles 12
Prospective ECG-Triggering Versus
Retrospective ECG-Gating 14
Placement of ECG-Electrodes 15
Preview Series Reconstruction 16
ECG-Trace Editor 17
ECG-Pulsing 18
ACV on/off 19
ASA-Filter 20
How to do it 21
Calcium Scoring 21
Hints in General 22
CaScore06s 23
CaScoreSeq 24
CaScoreSeq06s 25
CoronaryCTA 26
Hints in General 26
CoronaryCTA06s 28
Aortic and Pulmonary Studies 29
ThoraxECGHR 30
ThoraxECGHR06s 31
ThoraxECG06s 32
Additional Important Information 34
4
Content
Bolus Tracking 38
The Basics 38
How to do it 40
CARE Bolus 40
General Hints 40
TestBolus 42
TestBolus06s 42
Dental CT 46
The Basics 46
How to do it 47
OsteoCT 52
The Basics 52
How to do it 53
Pulmo CT 58
The Basics 58
Siemens Reference Data 59
User-Specific Reference Data 59
How to do it 59
Perfusion CT 62
The Basics 62
How to do it 64
BrainPerfCT 64
EarlyStroke 65
BrainPerfSingle 66
Dynamic Scanning 72
BodyDynCT 73
BodyDynSingle 73
5
Content
Interventional CT 74
The Basics 74
How to do it 75
Biopsy 75
Biopsy06s 75
BiopsyCombine 76
BiopsyCombine06s 77
Trauma 80
The Basics 80
How to do it 81
PolyTrauma 82
PolyTrauma06s 82
LungCARE 84
LungCARE 84
LungCARE06s 85
Functionalities 87
Colonography 88
CT Colonography 88
CT Colonography06s 89
Appendix 92
Osteo CT 92
Pulmo CT 94
6
Content
7
HeartView CT
HeartView CT
HeartView CT is a clinical application package specifi-

cally tailored to cardiovascular CT studies.
The Basics
Important Anatomical Structures of the Heart

Four chambers:
Right atrium receives the deoxygenated blood
from the body circulation through the superior and
inferior vena cava, and pumps it into the right ventricle
Right ventricle receives the deoxygenated blood
from the right atrium, and pumps it into the pulmo-
nary circulation through the pulmonary arteries
Left atrium receives the oxygenated blood from
the pulmonary circulation through the pulmonary
veins, and pumps it into the left ventricle
Left ventricle receives the oxygenated blood from
the left atrium, and pumps it into the body circulation
through the aorta
8
HeartView CT
Fig. 1:
A Blood fills both atria
P
LV
RV
Fig. 2:
Atria contract, blood
enters ventricles
LA
RA
Fig. 3:
Ventricles contract,
blood enters into
aorta and pulmonary
arteries
A: Aorta
P: Pulmonary Artery
RV: Right Ventricle
LV: Left Ventricle
RA: Right Atrium
LA: Left Atrium
9
HeartView CT
Coronary arteries:
Right coronary artery (RCA)
Right coronary artery supplies blood to the right
atrium, right ventricle, and a small part of the ven-
tricular septum.
SVC A
PA
RA
RV
IVC
Fig. 4: Front view Fig. 5: Conventional

Angiography
SVC: Superior Vena Cava

IVC: Inferior Vena Cava
RA: Right Atrium
RV: Right Ventricle
A: Aorta
PA: Pulmonary Artery
Left coronary artery (LCA)

Left coronary artery supplies blood to the left atrium,
left ventricle and a large part of the ventricular septum.
LM
LAD

Cx
Fig. 6: Front view Fig. 7: Conventional

Angiography
LM: Left Main Artery

LAD: Left Anterior Descending Artery
Cx: Circumflex Artery
10
HeartView CT
Cardiac Cycle and ECG

The heart contracts when pumping blood and rests
when receiving blood. This activity and lack of activity
from a cardiac cycle, can be illustrated by an Electro-
cardiograph (ECG) (Fig. 8).
P T
U
Q S
Ventricular contraction Ventricular

Systolic phase Relaxation
Atrial contraction
Diastolic phase
Fig. 8
To minimize motion artifacts in cardiac images, two

requirements are mandatory for a CT system:
Fast gantry rotation to minimize the time it takes
to acquire the necessary scan data to reconstruct an
image.
Prospective triggering of image acquisition in a
sequential mode or retrospective gating of image
reconstruction in a spiral mode based on the ECG
recording in order to obtain images during the
diastolic phase with least cardiac motion.
Temporal Resolution
Temporal resolution, also called time resolution,
represents the time window of the data that is used for
image reconstruction. It is essential for cardiac CT
imaging the higher the temporal resolution, the fewer
the motion artifacts. With the SOMATOM Emotion 6,
temporal resolution can be achieved down to 150 ms.
11
HeartView CT
Technical Principles
Basically, there are two different technical approaches
for cardiac CT acquisition:
Prospectively ECG triggered sequential scanning.
Retrospectively ECG gated spiral scanning.
In both cases, an ECG is recorded and used to either
initiate prospective image acquisition (ECG triggering),
or to perform retrospective image reconstruction (ECG
gating). Only scan data acquired in a user-selectable
phase of cardiac cycle is used for image reconstruction.
The temporal relation of the image data interval rela-
tive to the R-waves is predefined, which can be either
relative (given as a certain percentage of the RR-inter-
val time) or absolute (given in ms) and either forward
or reverse.
Relative delay: a given percentage of R-R interval
(%RR) relative to the onset of the previous or the next
R-wave (Fig. 9, 10).
50 % of R-R
Scan/
Recon
ECG (t)
Time
Fig. 9
-50 % R-R
Scan/
Recon
ECG (t)
Time
Fig. 10
12
HeartView CT
Absolute delay: a fixed time delay after the onset of

the R-wave (Fig. 11).
400 msec
Scan/
Recon
ECG (t)
Time
Fig. 11
Absolute reverse: a fixed time delay prior to the

onset of the next R-wave (Fig. 12).
Estimated
Scan/ R-Peak
Recon
ECG (t)
- 400 msec
Time
Fig. 12
13
HeartView CT
Prospective ECG-Triggering Versus Retrospective

ECG-Gating
With prospective ECG-triggering, the heart volume is
covered in a step-and-shoot technique. The patients
ECG-signal is used to start sequential scans with a
pre-defined offset to the R-waves of the patients ECG.
With retrospective ECG-gating, the heart volume is
covered continuously by a spiral scan. The patients
ECG-signal is recorded simultaneously to allow a
retrospective selection of the data segments used for
image reconstruction. Prospective ECG-triggering
has the benefit of smaller patient dose than ECG-gated
spiral scanning, since scan data is acquired in the pre-
viously selected heart phases only. It does, however,
not provide continuous volume coverage with over-
lapping slices and mis-registration of anatomical details
may occur. Furthermore, reconstruction of images in
different phases of the cardiac cycle for functional
evaluation is not possible. Since ECG-triggered sequen-
tial scanning depends on a reliable prediction of the
patients next RR-interval by using the mean of the
preceding RR-intervals, the method should not be used
for patients with arrhythmia and irregular heart rates.
To maintain the benefits of ECG-gated spiral CT but
reduce patient dose ECG-controlled dose-modulation
is available.
14
HeartView CT
Placement of ECG-Electrodes
The correct placement of the ECG electrodes is essen-
tial in order to receive a clear ECG signal with marked
R-Waves. Incorrect placement of the electrodes will
result in an unstable ECG signal which is sensitive to
movements of the patient during the scan.
US Version (AHA standard)
White Electrode
on the right mid-clavicular line, directly below the
clavicle
Black Electrode:
on the left mid-clavicular line, 6 or 7 intercostal space
Red Electrode:
right mid-clavicular line, 6 or 7 intercostal space
Europe Version (IEC standard)

Red Electrode
on the right mid-clavicular line, directly below the
clavicle
Yellow Electrode:
on the left mid-clavicular line, 6 or 7 intercostal space
Black Electrode:
right mid-clavicular line, 6 or 7 intercostal space
15
HeartView CT
Preview Series Reconstruction

The Preview Series should be used to define the optimal
time window for image reconstruction in ECG-gated
spiral scanning, before the full series is reconstructed.
A default value of 60% relative gating (or -400 ms
absolute reverse gating) can be used as an initial setup
for the optimization process which is best performed
as follows:
select an image level displaying the mid RCA.
choose 60% (or -400 ms ) reconstruction phase
setting.
reconstruct a preview series at this level of the RCA
by clicking on the Preview Series button in the
Trigger card: a series of images with different phase
setting at the selected anatomical level of the RCA
will be reconstructed.
choose the image with least motion artifacts.
reconstruct the whole dataset with the phase setting
you selected. Please note that you have to enter this
phase setting manually in the Trigger card.
An example for a preview series at the correct ana-
tomical level with optimal and sub-optimal selection
of the phase setting is shown below. Usually this
procedure results in good image quality for the right
and the left coronary artery. Especially at higher and
inconsistent heart rates individual optimization for
left and right coronary artery may be necessary. In
most cases, the RCA requires an earlier phase in the
cardiac cycle to obtain the period of least motion,
e. g. RCA at 40%, LAD at 60%.
16
HeartView CT
Example of a preview series at the correct anatomical

level (mid RCA), demonstrating the importance of opti-
mized phase setting. Patient with an average heart
rate of 63 bpm.
Left: 57%, mid: 61%, right: 65% relative delay.
The image at 61% relative delay shows the least motion
artifacts. In this example, even a slight change of
the phase setting from 61% to 65% deteriorates image
quality.
ECG-Trace Editor
The ECG trace editor is used to modify the ECG signal.
This editing tool is available after spiral scan data have
been acquired. By using the right mouse menu on the
Trigger card you have access to several modification
tools for the ECG Sync, such as Delete, Disable, Insert.
In patients with only single or few extra-systolic beats
overall image quality may be improved by editing the
ECG prior to reconstruction. Deleting the corresponding
R-peaks prevents image reconstruction in the extra-
systolic heart periods.
Please keep in mind that absolute gating (in ms) must
be chosen if R-peaks are deleted. Although ECG-gated
spiral scanning is less sensitive to variable heart rates
than ECG-triggered sequential scanning, the examina-
tion of patients with complex arrhythmia that results
in unpredictable variations of the RR-intervals (e. g.
complex ventricular arrhythmia or multiple extra beats)
can result in limited image quality and should be per-
formed in exceptional cases only.
17
HeartView CT
ECG-Pulsing
ECG-pulsing is a dedicated technique used for online
dose modulation in ECG-gated spiral scanning. During
the spiral scan, the output of the X-ray tube is modu-
lated according to the patients ECG. It is kept at its nomi-
nal value during a user-defined phase of the cardiac
cycle, in general the mid- to end-diastolic phase.
During the rest of the cardiac cycle, the tube output is
reduced to 20% of its nominal value. The length of the
plateau with full dose is 470 ms, which is sufficient to
retrospectively shift the image reconstruction interval
for patient-individual fine-tuning of the image recon-
struction phase. The tube current is reduced and not
switched off to allow for image reconstruction through-
out the entire cardiac cycle. Even though their signal-
to-noise ratio is decreased, the low-dose images are
sufficient for functional evaluation. Clinical studies have
demonstrated dose reduction by 30-50% depending
on the patients heart rate using ECG-pulsing. ECG-
pulsing can be switched on/off by the user on the
Trigger card (Fig. 14). When using ECG-pulsing, the
desired reconstruction phase has to be estimated and
entered into the Trigger card prior to scanning, since
it determines the time interval of maximum dose.
Fig. 14: Dose modulation with ECG pulsing.
18
HeartView CT
ACV on/off
On the Trigger card, ACV (Adaptive Cardio Volume
reconstruction) can be switched on/off by the user.
With ACV off, single segment reconstruction is per-
formed for all heart rates. Data acquired in one heart
cycle are used for the reconstruction of each image,
and the temporal resolution is independent of the
heart rate. Temporal resolution is 300 ms for 0.6 s
gantry rotation time. With ACV on, the system auto-
matically switches between single segment and two
segment reconstruction depending on the patients
heart rate. For heart rates below 67 bpm at 0.6 s
gantry rotation time, single segment reconstruction is
performed. For heart rates exceeding 67 bpm, two
segment reconstruction is performed, using scan data
acquired in two subsequent heart cycles to improve
temporal resolution. With ACV on, temporal resolution
is constant for heart rates below 67 bpm (300 ms for
0.6 s gantry rotation time). For heart rates above 67
bpm, temporal resolution varies between 150 ms and
300 ms depending on the patients heart rate, reach-
ing its optimum (150 ms) at 80 bpm. We recommend
to switch ACV on.
ACV-Reconstruction with 0.6 sec. rotation time

0.32
0.3
0.28
temporal resolution in sec.
0.26
0.24
0.22
0.2
0.18
0.16
0.14
40 50 60 70 80 90 100 110
Heart rate in bpm
Fig. 15: Temporal resolution as a function of the

patients heart rate for 0.6 s gantry rotation time.
19
HeartView CT
ASA-Filter
ASA: The Advanced Smoothing Algorithm (ASA)
filter reduces noise in soft tissue while edges with high
contrast are preserved. For the software VA70 the
ASA-filter is routinely available and can be selected in
each ECG-gated spiral scan protocol.
We recommend to reconstruct 1.25 mm slices and use
the kernel B31s for standard coronary CTA, including
MPR, MIP and VRT.
For detail viewing, the use of kernel B46s in combi-
nation with the ASA-filter may yield superior results.
20
HeartView CT
How to do it
Calcium Scoring
This application is used for identification and quan-
tification of calcified lesions in the coronary arteries. It
can be performed with both Prospective ECG trigger-
ing (sequential scanning) and Retrospective gating
(spiral scanning) techniques. The following scan proto-
cols are predefined:
CaScor06s
Standard spiral scanning protocol with ECG gating
and a 0.6 s rotation time (optional)
CaScoreSeq
Sequential scanning protocol with ECG triggering,
using a 0.8 s rotation time
CaScoreSeq06s
Sequential scanning protocol with ECG triggering,
using a 0.6 s rotation time (optional)
21
HeartView CT
Hints in General
The two kernels B35s and B46s are especially

designed for cardiac application, in particular, B35s
should be used for calcium scoring, and B46s for
patency of stents.
Use the ECG-triggered protocol for low-dose scanning
except for patients with arrhythmia. Use the ECG
gated protocol when accuracy and/or reproducibility
are essential, e. g. for follow-up studies of calcium
scoring.
With 0.6 s gantry rotation time, temporal resolu-
tion varies between 150 ms and 300 ms depending
on the patients heart rate.
We recommend a tube voltage of 130 kV. To
reduce patient dose, tube voltage may be lowered
to 110 kV.
22
HeartView CT
CaScore06s
Indications:
This is a standard spiral scanning protocol, using
an ECG gating technique for coronary calcium scoring
studies, with a rotation time of 0.6 seconds.
Topogram:
AP, 512 mm.
From the carina to
the apex of the heart.
A typical range of
12 cm covering the
entire heart can
be done in 16.5 s.
CaScore
kV 130
Effective mAs 30
Slice collimation 2.0 mm
Slice width 3.0 mm
Feed/Rotation 4.8 mm
Rotation time 0.6 sec.
Temporal resolution up to 150 ms*
Kernel B35s
Increment 2.5 mm
Image order cr-ca
CTDIVol 3.4 mGy
* Depends on heart rate.
23
HeartView CT
CaScoreSeq
Indications:
This is a sequential scanning protocol using an ECG
triggering technique for coronary calcium scoring
studies.
Topogram:
AP, 512 mm.
From the carina to
A typical scan range
covers 12 cm.
If you apply API for image acquisition, please make

sure that the breath-hold interval in the Patient Model
Dialog is longer than the total scan time, e. g. 50 s,
otherwise the image acquisition will be interrupted by
the default breath-hold interval. This does not apply
when API is not activated.
CaScoreSeq
kV 130
mAs 30
Slice width 3.0 mm
Feed/Scan 18.0 mm
Temporal resolution 400 ms
Kernel B35s
Image order cr-ca
CTDIVol 3.2 mGy
24
HeartView CT
CaScoreSeq06s
Indications:
This is a sequential scanning protocol using an
ECG triggering technique with 0.6 s rotation time for
coronary calcium scoring studies.
Topogram:
AP, 512 mm.
From the carina to
A typical scan range
covers 12 cm.
If you apply API for image acquisition, please make

sure that the breath-hold interval in the Patient Model
Dialog is longer than the total scan time, e. g. 50 s,
otherwise the image acquisition will be interrupted by
the default breath-hold interval. This does not apply
when API is not activated.
CaScoreSeq
kV 130
mAs 30
Slice width 3.0 mm
Feed/Scan 18.0 mm
Kernel B35s
Image order cr-ca
CTDIVol 3.2 mGy
25
HeartView CT
Coronary CTA
This is an application for imaging of the coronary
arteries with contrast medium.
We recommend to use only ECG gated spiral scanning.
The following scan protocol is predefined:
CoronaryCTA06s
Standard spiral scanning protocol with ECG gating,
using a rotation time of 0.6 seconds (optional).
Hints in General
Contrast Medium:
For homogeneous contrast enhancement in the
coronary arteries optimized contrast protocols are
mandatory. The use of bolus tracking is helpful, with
an automatic start of the spiral scan as soon as a
contrast threshold of 100 HU has been reached in the
ascending aorta. Please note that a correct placement
of the ROI in the ascending aorta is essential.
An example for an optimized contrast protocol is: Use
120 ml of contrast agent with a density of 350 mg/ml
at a flow rate of 3.5 ml/s followed by 40 ml of saline
chaser (double head injector).
For further information on the Bolus Tracking Appli-
cation, please refer to the chapter Bolus Tracking.
To further optimize MPR image quality we recommend
that you reduce one or more of the following: colli-
mation, reconstruction increment, pitch factor while
using a wider slice width for image reconstruction.
We recommend to reconstruct 1.25 mm slices
and use the kernel B30s for standard coronary CTA,
including MPR, MIP and VRT.
26
HeartView CT
27
HeartView CT
CoronaryCTA06s
Indications:
This is a standard spiral scanning protocol, using a
rotation time of 0.6 s, with an ECG gating technique
for coronary CTA studies.
Topogram:
AP, 512 mm.
Approximately, from
the carina to the
apex of the heart.
A typical range of
12 cm covering the
entire heart can
be done in 31.8 s.
CoronaryCTA
kV 130
Effective mAs 280
Slice width 1.25 mm
Kernel B31s
Increment 0.8 mm
Image order cr-ca
CTDIVol 36.9 mGy
28
HeartView CT
Aortic-, Pulmonary- and High resoulution Studies

The purpose of these applications is to reduce motion
artifacts in the lung, the aorta and the pulmonary arte-
ries due to transmitted cardiac pulsation. It is intended
for imaging the aorta and pulmonary arteries with con-
trast medium and ECG-triggered sequential scanning
or ECG-gated spiral scanning, e. g. for aortic dissection
or pulmonary emboli. A special protocol is available
for high-resolution interstitial lung studies with ECG-
triggered sequential scanning. The following scan pro-
tocols are predefined:
ThoraxECGHR
Sequential scanning protocol with ECG triggering
and a high resolution kernel
ThoraxECGHR06s
Sequential scanning protocol with ECG triggering
using a high resolution kernel and a rotation time
of 0.6 sec. (optional)
ThoraxECG06s
Spiral scanning protocol with ECG gating using
a rotation time of 0.6 sec. (optional)
29
HeartView CT
ThoraxECGHR
Indications:
This is a sequential scanning protocol with an ECG
triggering technique for interstitial studies of the lungs,
especially for the lesions in the pericardial region.
Topogram:
AP, 512 mm.
From the apex of
the lung to the lung
base. A typical scan
range covers 12 cm.
ThorECGHR
kV 130
mAs 70
Slice width 1.0 mm
Feed/Scan 10.0 mm
Kernel B90s
Image order cr-ca
CTDIVol 0.7 mGy
30
HeartView CT
ThoraxECGHR06s
Indications:
This is a sequential scanning protocol, using a rotation
time of 0.6 sec. with an ECG triggering technique
for interstitial studies of the lungs, especially for the
lesions in the pericardial region.
Topogram:
AP, 512 mm.
From the apex of
the lung to the lung
base. A typical scan
range covers 12 cm.
ThoraxECGHR
kV 130
mAs 70
Slice width 1.0 mm
Feed/Scan 10.0 mm
Kernel B90s
Image order cr-ca
CTDIVol 0.73 mGy
31
HeartView CT
ThoraxECG06s
Indications:
This is a spiral scanning protocol with an ECG gating
technique, using 0.6 s rotation time for aortic and pul-
monary studies, e. g. aortic dissection or pulmonary
emboli.
Topogram:
AP, 512 mm.
From the aorta arch
to the tip of the
sternum.
A range of 12.5 cm
can be covered in
16.5 s.
ThorECG
kV 130
Effective mAs 115
Slice width 3.0 mm
Kernel B31s
Increment 2.0 mm
Image order cr-ca
CTDIVol 13.0 mGy
32
HeartView CT
33
HeartView CT
Additional Important
Information
By default, the Synthetic Trigger (ECG triggered
scanning) or Synthetic Sync (ECG gated scanning) is
activated for all predefined cardiac scan protocols
(Fig. 1 and 2). It is recommended to keep it always
activated for examinations with contrast medium.
In case of ECG signal loss during the acquisition, this
will ensure the continuation of the triggered scans or
allows an ECG to be simulated for retrospective gating.
If it is deactivated, the scanning will be aborted in case
of ECG signal loss during the acquisition.
Fig. 1
Fig. 2
34
HeartView CT
You can activate the Auto load in 3D function on the

Examination card/Auto Tasking and link it to a recon
job. If the postprocessing type is chosen from the pull
down menu, the reconstructed images will be loaded
automatically into the 3D card on the Navigator with
the corresponding postprocessing type.
On the 3D card you have the possibility to create MPR,
MIPthin Range Parallel and Radial protocols which can
be linked to a special series.
For example, if you always do MIP Reconstructions for
a Coronary CTA examination, you load once the images
into the 3D card. Select the image type (e. g. MIPthin)
and the orientation, and then open the Range Parallel
function. Adapt the range settings (Image thickness,
Distance between the images etc.), hit the link and
save button. From this point on, you have a predefined
post-processing protocol, linked to the series descrip-
tion of a coronary CTA examination.
Exactly the same can be done for VRT presets. In the
main menu, under Type/VRT Definition, you can link
and save VRT presets with a series description.
Some of the Scan protocols are preset with links to a
postprocessing protocol. If you prefer to set your own
presets, please delete the Range Parallel preset or
overwrite them with your own settings.
35
HeartView CT
Calcium Scoring evaluation is performed on a separate

syngo task card:
1. The threshold of 130 HU is applied for score
calculation by default, however, you can modify it
accordingly.
2. In addition to the seeding method, you can use
freehand ROI for the definition of lesions.
3. The separation and modification of lesions within
a defined volume (depth in mm) can be performed
not only on 2D slices, but also with 3D editing.
4. For easier identification of small lesions, you can
blowup the display with a doubleclick.
5. You can customize hospital/office information on
the final report using Report Configuration.
6. You can generate HTML report including site spe-
cific information, free text and clinical images. This
then can be saved on floppy disc and/or printed.
7. The results are displayed online in a separate
segment including the following information:
Area (in mm3)
Number of lesions
Peak density (in HU)
Volume (in mm3)
Calcium mass (mg calcium Hydroxyapatite)
Score (Agatston method)
8. The results can be printed on laser film, paper
printer or saved into data base.
36
HeartView CT
User interface of syngo Calcium Scoring
37
Bolus Tracking
The Basics
The administration of intravenous (IV) contrast

material during spiral scanning improves the detection
and characterization of lesions, as well as the opacity
of vessels. The contrast scan will yield good results
only if the acquisition occurs during the optimal phase
of enhancement in the region of interest. Therefore,
it is essential to initiate the acquisition with the correct
start delay. Since Multislice spiral CT can provide much
faster speed and shorter acquisition time, it is even
more critical to get the right timing to achieve optimal
results (Fig. 1a, 1b).
40 s scan 10 s scan
Fig. 1a: Longer scan time Fig. 1b: Shorter scan time
The dynamics of the contrast enhancement is

determined by:
Patient cardiac output
Injection rate (Fig. 2a, 2b)
Total volume of contrast medium injected
(Fig. 3a, 3b)
Concentration of the contrast medium (Fig. 3b, 4a)
Type of injection uni-phasic or bi-phasic (Fig. 4a, 4b)
Patient pathology
38
Bolus Tracking
Aortic time-enhancement curves after i.v. contrast

injection (computer simulation*).
All curves are based on the same patient parameters
(male, 60-year-old, 75 kg).
* Radiology 1998; 207:647-655
300 300
Relative Enhancement [HU]

250 250
200 200
150 150
100 100
50 50
0 0
0 20 40 60 80 100 120 0 20 40 60 80 100 120
Time [s] Time [s]
Fig. 2a: 2 ml/s, Fig. 2b: 4 ml/s,

120 ml, 300 mg I/ml 120 ml, 300 mg I/ml
300 300
250 250
200 200
150 150
100 100
50 50
0 0
0 20 40 60 80 100 120 0 20 40 60 80 100 120
Time [s] Time [s]
Fig. 3a: 80 ml, Fig. 3b:120 ml,

4 ml/s, 300 mg I/ml 4 ml/s, 300 mg I/ml
400 300
350
250
300
200
250
200 150
150
100
100
50
50
0 0
0 20 40 60 80 100 120 0 20 40 60 80 100 120
Time [s] Time [s]
Fig. 4a: Uni-phase Fig. 4b: Bi-phase

140 ml, 4 ml/s, 70 ml, 4 ml/s, plus 70 ml,
370 mg I/ml 2 ml/s, 370 mg I/ml
39
Bolus Tracking
How to do it
To achieve optimal results in contrast studies, the use

of CARE Bolus is recommended. In case it is not available,
use Test Bolus.
CARE Bolus
This is an automatic bolus tracking program, which

enables triggering of the spiral scanning at the optimal
phase of the contrast enhancement.
General Hints:
1. This mode can be applied in combination with
any spiral scanning protocol. Simply insert Bolus
tracking by clicking the right mouse button in
the chronicle. This inserts the entire set up including
pre-monitoring, i.v. bolus and monitoring scan
protocol. You can also save the entire set up as your
own scan protocols (please refer to the application
guide for routine protocols).
2. The pre-monitoring scan is used to determine the
level of monitoring scans. It can be performed at
any level of interest. You can also increase the mAs
setting to reduce the image noise when necessary.
3. To achieve the shortest possible spiral start delay
(2 s), the position of the monitoring scans relative
to the beginning of spiral scan must be optimized.
A snapping function is provided:
40
Bolus Tracking
After the Topogram is performed, the predefined

spiral scanning range and the optimal monitoring
position will be shown.
If you need to redefine the spiral scanning range,
you should also reposition the monitoring scan in
order to keep the shortest start delay time (2 s).
(The distance between the beginning of the spiral
scanning range and the monitoring scan will be
the same).
Move the monitoring scan line towards the opti-
mal position and release the mouse button, it will
be snapped automatically. (Trick: if you move the
monitoring scan line away from the optimal posi-
tion the snapping mechanism will be inactive).
4. Place a ROI in the premonitoring scan on the
target area or vessel used for triggering. (The ROI
is defined with double circles the outer circle is
used for easy positioning, and the inner circle is
used for the actual evaluation). You can also zoom
the reference image for easier positioning of the
ROI.
5. Set the appropriate trigger threshold, and start
contrast injection and monitoring scans at the same
time.
During the monitoring scans, there will be simul-
taneous display of the relative enhancement of the
target ROI. When the predefined density is reached,
the spiral acquisition will be triggered automatically.
6. You can also initiate the spiral any time during the
monitoring phase manually either by pressing the
START button or by clicking the START key. If you
do not want to use automatic triggering, you can
deselect it.
41
Bolus Tracking
TestBolus
Indications:
This mode can be used to test the start delay of an
optimal enhancement after the contrast medium
injection.
TestBolus
kV 110
Effective mAs 20
Slice width 10.0 mm
Feed/Scan 0 mm
Kernel B31s
Cycle time 1.2 sec.
TestBolus06s
Indications:
This mode can be used to test the start delay of an
optimal enhancement after the contrast medium
Injection, using with 0.6 rotation time (optional).
TestBolus06s
kV 110
Effective mAs 20
Slice width 10.0 mm
Feed/Scan 0 mm
Kernel B31s
Cycle time 1.2 sec.
42
Bolus Tracking
Application procedures:
1. Select the spiral mode that you want to perform,
and then Append the TestBolus mode under Special
protocols.
2. Insert the Test Bolus mode above the spiral mode
for contrast scan by cut/paste (with right mouse
button).
3. Perform the Topogram, and define the slice position
for TestBolus.
4. Check the start delay, number of scans and cycle
time before loading the mode.
5. A test bolus with 10-20 ml is then administered
with the same flow rate as during the subsequent
spiral scan. Start the contrast media injection and
the scan at the same time.
6. Load the images into the Dynamic Evaluation
function and determine the time to the peak enhance-
ment.
Alternatively, on the image segment, click select series
with the right mouse button and position an ROI on
the first image. This ROI will appear on all images in
the test bolus series. Find the image with the peak HU
value, and calculate the time delta t taken to reach
the peak HU value (do not forget to add the preset
start delay time). This time can then be used as the
optimal start delay time for the spiral scan.
43
Bolus Tracking
Information
1.The preset start delay time for monitoring scans
depends on whether the subsequent spiral scan will
be acquired during the arterial phase or venous
phase. The default value is 10 s. You can modify it
accordingly.
2. It should be pointed out that when using Test
Bolus, there may be residual contrast in the liver
and kidneys prior to scanning. This may result in
an inaccurate arterial and equilibrium phase.
3. The trigger threshold is not an absolute value but
a relative value compared to the non-contrast scan.
E. g. if the CT value is 50 HU in the non-contrast
image, and your trigger level is 100 HU, then the
absolute CT value in the contrast image will be
150 HU.
4. If you change slice collimation, rotation time or kV
in the spiral scanning protocol after CARE Bolus
is inserted, a longer spiral start delay time will be
the result, e. g. 14 s. This is due to the necessary
mechanical adjustments, e. g. moving the slice
collimators. Therefore, it is recommended that you
modify the parameters of the spiral scanning
before inserting the CARE Bolus.
44
Bolus Tracking
5. If API is used in conjunction with CARE Bolus, the

actual start delay time for the spiral will be as long
as the length of API including the predefined start
delay time. E. g. if the predefined the start delay is
2 s, and the API lasts 5 s, the spiral will start 5 s after
the threshold is reached.
6. In case you have to interrupt the monitoring
scanning due to injection problems, you can repeat
it afterwards by inserting CARE Bolus again with a
right mouse click. The same Topogram can still be
used.
45
Dental CT
Dental CT
This is an application package for reformatting pano-

ramic views and paraxial slices through the upper and
lower jaw. It enables the display and measurement
of the bone structures of the upper and lower jaw
(especially for a 1:1 scale) as the basis for OP planning
in oral surgery.
The Basics
What is the relevant anatomical information for oral

surgery planning and dental implantation?
Location of the socket for dental implant
Buccal and lingual thickness of the cortical com-
ponent of the alveolar process
Position of the mandibular canal and the mental
foramen
Extent of the nasal sinuses and position and width
of the floor of the nasal cavity.
What can Dental CT do?

Reformatting of a curvilinear range of panoramic
views along the jaw-bone.
Reformatting of paraxial views of selectable length
and at selectable intervals perpendicular to the
panoramic views.
Presentation of results in the form of multiple image
display with reference markings.
Images are documented on film in real-size so that
the direct measurement of the anatomic information
with a ruler is possible. The layout of the film sheet is
predefined such that it can accommodate the maxi-
mum number of reformatted images.
46
Dental CT
Fig. 1:
Panoramic view
Fig. 2:
Paraxial view
How to do it
Scan Protocol
A typical scan range of 5 cm can be done in 10.5 s.
Dental
kV 130
Effective mAs 45
Slice width 1.0 mm
Kernel H70s
Increment 0.5 mm
Image order cr-ca
CTDIVol 12.8 mGy
47
Dental CT
It is mandatory to position the patient head in the

center of the scan field use the lateral laser light
marker for positioning.
Gantry tilt is not necessary since you have the pos-
sibility to tilt the reference line to generate an axial
reformatted image at the desired plane. However,
in order to minimize the scan length for the same
anatomical region, it is recommended to position the
patients head at the appropriate scan plane when-
ever possible:
For the upper and lower jaw:
occlusal plane in parallel to the scan plane.
For either jaw:
jaw bone in parallel to the scan plane.
It is recommended to end the exam first, and then
start the Dental evaluation.
Fig. 3: User interface of syngo Dental
48
Dental CT
Information
This protocol delivers high resolution images for
Dental CT evaluation, however, you can also recon-
struct images with softer kernel, e. g. H20s, for
3D/SSD postprocessing.
Fig. 4a:
AP-cranial view
Fig. 4b:
Caudal view
Image orientation:
In the paraxial view, a B indicates buccal and
a L lingual. The lingual marker + must always be
positioned at the tongue. If not, simply drag & drop
it back.
In the panoramic view, a B stands for Begin and
an E for End.
Filming: for the maximum use of the film, film directly
from the Dental Card instead of Patient Browser.
For easy reprinting, the results of the latest Dental CT
Film are stored in the Patient Browser in the folder
Film.
It is better to change the image windowing on the
virtual film sheet.
A semi-automatic detection tool can be used to mark
and outline the mandibular canal on both paraxial
and panoramic images for easy viewing and filming.
49
Dental CT
Multiple paraxial ranges can be defined on one

reference image by cluster & copy function. I. e.,
you can group a number of paraxial lines and copy
the lines to another location, e. g. over individual
sockets at different locations (Fig.5).
ROI definition for statistical evaluations and deletion
of graphics are possible.
Fig. 5
Paraxial lines using
Cluster.
50
Dental CT
51
Osteo CT
Osteo CT
This is an application package for the quantitative

assessment of vertebral bone mineral density for
the diagnosis and follow-up of osteopenia and osteo-
porosis.
The Basics
This program enables the quantitative determination

of bone mineral density of the spine in mg/ml of calcium
hydroxyapatite (CaHA) for the diagnosis, staging, and
follow-up of osteopenia and osteoporosis with CT. The
patient is scanned together with the water- and bone-
equivalent calibration phantom.
What is T-score?
This is the deviation of average BMD of the patient
from that of a young healthy control. It represents
bone loss with reference to the peak bone mass.
What is Z-score?
This is the deviation of average BMD of the patient
from that of a healthy person of the same age. It is an
indicator of biological variability.
Siemens Reference Data:

The Siemens reference data was acquired at three
European centers, including 135 male and 139 female
subjects, 20 to 80 years of age.
52
Osteo CT
How to do it
Osteo
kV 80
mAs 110
Slice width 10 mm
Feed/Scan 0 mm
Kernel S80s
Image order cr-ca
CTDIVol 2.9 mGy
OsteoObese
kV 80
mAs 230
Slice width 10 mm
Feed/Scan 0 mm
Kernel S80s
Image order cr-ca
CTDIVol 6.1 mGy
The special kernels are mostly used for physical

measurements with phantoms, e. g. for adjustment
procedures (S80s), for constancy and acceptance tests
(S80s, U90s), or for specification purposes (U90s).
For special patient protocols, S80s and U90s are chosen,
e. g. for osteo (S80s) and for high resolution bone stu-
dies (U90s). We recommend to use the high resolution
specification kernel U90s only with small objects, like
the wrist, otherwise artifacts will occur in the images.
53
Osteo CT
Patient positioning:
Set the table height at 125. The gantry tilt will be
available from 22 to +22.
Patients should be positioned so that they are as
parallel to the patient table as possible. Support the
knees to compensate for lordosis.
The calibration phantom should be positioned
directly below the target region. Put the Gel-pad bet-
ween the calibration phantom and the patient to
exclude air pockets.
Scanning:
Typically, one scan each is performed at L1, L2 and
L3 levels. It is recommended to use image comments
L1, L2, L3 prior to scanning. These comments will be
displayed with the Osteo evaluation results.
Before ending the examination, you can drag & drop
the chronicles to the topogram segment to get the
Topographics, i. e. the cut lines for each vertebra on
the topogram.
Select the appropriate scan protocol according to the
patient size, i. e. use OsteoObese for obese patient.
Position the cut line of scanning through the middle
of the vertebra, i. e. bi-sector between the angle of the
upper and lower end plate.
The phantom must be included in the FoV of the
images for evaluation.
start the Osteo evaluation.
54
Osteo CT
Fig. 1:
Topographic
Fig. 2:
Phantom inside
the FoV
55
Osteo CT
Information
Fractured vertebrae are not suited for Osteo CT

evaluation since the more compact nature of these
vertebrae result in bone mineral density value that
is much higher than one would expect.
How to save the results on your PC?
Select Option/Configuration from the main menu
and click icon CT Osteo.
Activate the checkbox Enable Export of Results.
Exit the configuration dialog.
Call up the Osteo card and you will see the new
icon Export results on the lower, right part of the
screen.
Click this icon to copy the evaluation results to
floppy disk (Note: with every mouse click on the
icon, the previous result file will be appended).
The data file can be transferred to your PC for
further evaluation, e. g. with MS Excel.
Note: for detailed information about the data file,
please refer to the Appendix.
It is recommended to film directly from the Osteo
card. Select images or series with Edit/Select all,
and click film icon. You can also configure film
layout, e. g. 3 x 3 as shown in figure 3 in Option/
Configuration/FilmingLayout.
56
Osteo CT
Fig. 3: Filming layout
Note: it is not recommended to use filming setting

of 4 x 5 segments since the image text elements of the
result image are overlapped and hard to read.
57
Pulmo CT
Pulmo CT
This is an application package, which serves for

quantitative evaluation of the lung density to aid the
diagnosis and follow-up of diffuse lung diseases,
such as pulmonary emphysema, sarcoidosis, pan-
bronchiolitis and silicosis.
The Basics
No specific scan protocols were set up for this option.

Scan protocols for routine thorax imaging can be
used. The scan parameters used are dependent on
the indications and objectives of the study design.
For example, spiral mode for lung volume evaluation
or HR sequence mode for interstitial lung diseases.
Lung density is influenced by respiratory status
(Fig.1).
Full Inspiration Full Expiration
Density = @ Density = >2 x @
Fig. 1: Lung density at full inspiration/expiration
58
Pulmo CT
Examinations should be acquired always at the same

respiratory level, usually at either full inspiration or
full expiration. Studies had shown that reproducibility
is high and is unlikely to be improved by using spiro-
metric gating [1].
Literature
1. Repeatability of Quantitative CT Indexes of
Emphysema in Patients
Evaluated for Lung Volume Reduction Surgery.
David s. Gierada et al, Radiology 2001 220: 448-454
Siemens Reference Data

This reference data was acquired from lung healthy
individuals at 50% vital capacity. Since Pulmo CT
program does not provide spirometric triggering for
the acquisition of the data set, it is not meaningful
to use Siemens reference data for comparison unless
the data is acquired under the same conditions.
User-Specific Reference Data

It is possible to integrate in your own reference data,
e. g. data acquired at full inspiration, for the evaluation.
Please contact the local Siemens representative for
further information.
How to do it

start the Pulmo evaluation.
Select the images that you want to evaluate, and
activate the program by clicking on the Pulmo icon.
59
Pulmo CT
Information
How to export the evaluation results to a floppy disc?
Select Option/Configuration from the main menu
and click icon Pulmo.
Activate the checkbox Enable Export of Results.
Exit the configuration dialog.
Call up the Pulmo card and you will see the new
icon Export results on the lower, right part of the
screen.
Click this icon to copy the evaluation results onto
floppy disk. (Note: with every mouse click on the
icon, the previous result file on the floppy will be
appended).
The data file can be transferred to your PC for
further evaluation, e. g. with MS Excel.
Note: for detail information about the data file,
please refer to the Appendix.
Standard and expert mode can be configured to your
needs.
Select Option/Configuration/Pulmo.
For example, if you want to determine the per-
centage area of the lung within a specific HU range,
use the card Subranges on the Configuration/
Pulmo dialog.
Color-coded display of HU subranges and percentiles
is possible. This allows direct visualization of the
different densities distribution within the lung.
The auto-contour detection can be used as editing
function for 3D postprocessing of lung images.
60
Pulmo CT
Fig. 2: User interface of syngo Pulmo
61
Perfusion CT
Perfusion CT
This is an application software package for the quan-

titative evaluation of dynamic CT data of the brain
following injection of a highly concentrated iodine
contrast bolus. The main application is in the differen-
tial diagnosis and management of acute ischemic
stroke.
The Basics
The software optimally supports the stringent time

and workflow requirements in an emergency setting
where time is brain.
Parameters generated include among others cerebral
blood flow (CBF), cerebral blood volume (CBV), the
time to local perfusion onset (Time-to-Start) and the
time to local perfusion peak (Time-to-Peak).
Example: A 44-year-old man was brought to the
hospital about 2 hours after the start of severe
neurological symptoms of stroke in the right hemis-
phere.
62
Perfusion CT
Fig. 1: User interface of syngo Perfusion
The CBF image shows a severe perfusion disturbance

(flow close to zero) in the insular cortex and the poste-
rior portion of the lentiform nucleus. In comparison to
the left hemisphere the remaining supply area of the
middle cerebral artery shows moderately reduced flow.
The CBV image shows the same severe reduction in
insular cortex and lentiform nucleus. In contrast to
the CBF image, however, the blood volume in the
remaining right MCA territory is close to normal, if it
is compared to the same area on the left side.
The time-to-peak image shows a general prolonga-
tion of values in the MCA territory indicating delayed
bolus arrival.
63
Perfusion CT
How to do it
Scan protocols
There are two Scan protocols available:
BrainPerfCT, a routine sequential head protocol and
a Multiscan with 3 mm collimation and 2 times a 9 mm
slice thickness.
Early stroke, a routine sequential head protocol and
a Multiscan with 3.0 mm collimation and one time
a 9.0 mm slice thickness. Afterwards a protocol for
CT angiography of the carotids is appended.
BrainPerfSingle, a routine sequential head protocol
and a Multiscan with 5.0 mm collimation and one time
a 10 mm slice thickness.
BrainPerfCT BaseSeq CerebrumSeq DynMul

kV 130 130 80
mAs 300 270 220
Slice collim. 3.0 mm 3.0 mm 3.0 mm
Slice width 3.0 mm 9.0 mm 9.0 mm
Feed/Rotation
Feed/Scan 18.0 mm 18.0 mm 0.0 mm
Cycle time 3.0 sec. 3.0 sec.
Rotation time 1.0 sec. 1.0 sec. 1.0 sec.
Kernel H31s H31s H31s
Increment 1.0 sec.
Image order ca-cr ca-cr ca-cr
64
Perfusion CT
EarlyStroke BaseSeq CerebrumSeq DynMul

kV 130 130 80
mAs 300 270 220
Slice collimation 3.0 mm 3.0 mm 3.0 mm
Feed/Scan 18.0 mm 18.0 mm
Increment 1.0 sec.
AngioCarotid
kV 110
Effective mAs 60
Slice width 1.25 mm
Kernel B31s
Increment 0.8 mm
Image order ca-cr
65
Perfusion CT
BrainPerfSingle BaseSeq CerebrumSeq DynMul

kV 130 130 80
mAs 300 270 200
Slice collimation 3.0 mm 3.0 mm 5.0 mm
Feed/Scan 18.0 mm 18.0 mm
Increment 1.0 sec.
Such a standard protocol may be slightly modified for

specific reasons; e. g. the start delay can be increased
by a few seconds for patients with very low cardiac
output.
IV injection protocol
Contrast medium Non-ionic
Concentration 300 370 ml
Injection rate 8 ml/sec.
Total volume 40 ml
Total injection time ~ 5 sec.
Start delay time 4 sec
The technique requires a short bolus. The original

studies were performed mostly using 50 ml injected at
10 ml/s.
The routine application has shown, that by sacrificing
some of the spatial resolution, the examination can also
be done with smaller amounts of contrast (35 to 40 ml)
and correspondingly smaller flow rates. The smaller the
total amount the more helpful it is to consider a saline
chaser bolus. In any case, a state-of-the-art power
injector is recommended.
66
Perfusion CT
If a flow rate of 8 ml/s is considered not recommen-

dable for a specific patient, the protocol can be reduced
to 40 ml at 5ml/s. Image quality will be reduced but
the technique will still be diagnostic.
Additional measures to facilitate the injection, like
using a large gauge cannula (16 or 18 are usually
sufficient) and warming the contrast media to body
temperature to reduce its viscosity, should be con-
sidered.
Note: As with any contrast medium application,
verify that the particular models and brands that you
use in the chain injector/contrast medium/cannula
are approved by their respective manufactures for
the use with the parameters you select.
Motion during acquisition must be avoided. There-
fore, if at all possible you should try to explain the
course of the examination to the patient and use
additional head fixation in any case.
The standard examination slice is best positioned
such that it cuts through the basal ganglia at the level
of the inner capsule. This selection includes those
vascular territories of the brain that are frequently
affected by perfusion impairment associated with
acute stroke in the carotid territory.
The slice should be selected flatter than in normal
head CT scan, the angulation should be adjusted per-
pendicular to the occipital segment of the superior
sagittal sinus well above the confluence of sinuses.
The eye lens should never be positioned in the scan
plane.
Example of a
standard slice
through the basal
ganglia in a
lateral topogram.
67
Perfusion CT
Information
1. Why short injection times are necessary?
The brain has a very short transit time (approx. 3 to
5 seconds) and a relatively small fractional blood volume
(approx. 2 to 5%). This requires a compact bolus for
optimal time resolution and a certain minimum amount
of contrast for optimal signal to noise ratio. Bolus defi-
nition can be significantly improved and the amount
of contrast necessary reduced by using a saline chaser
bolus with the same flow rate directly following the
CM injection.
2. What do normal, contrast-enhanced and Perfusion

CT images show?
In order to interpret Perfusion CT images correctly,
it is essential to understand that they are functional
or parameter images that display a different type
of information than standard CT images: Normal CT
images basically show only morphological properties
of tissues by displaying their x-ray attenuation relative
to that of water as CT-values in HU-units.
Standard contrast-enhanced CT extends this limitation
either to make a compartment visible that normally
has low contrast (e. g. vascular structures in CTA) or
to qualitatively display major perfusion differences of
tissues (e. g. tumors or multiphase liver studies).
Perfusion CT tries to utilize all the information hidden
in the temporal changes of contrast enhancement by
fitting a mathematical model to the local time attenu-
ation curves. For each voxel this process yields a variety
of numbers which describe different aspects of tissue
perfusion. As the human eye is so much faster and
better suited to interpret images than large amounts
of numbers it makes sense to display these quantities
in the form of images.
68
Perfusion CT
3. What do pixel values mean in the Perfusion CT

images?
It is very important to realize that pixel values now
have a different meaning, which depends on the type
of image currently displayed. So if you point the cursor
into a parameter image bear in mind that you do not
read a CT-value but a functional unit. A time-to-peak
image, for example, displays numbers proportional to
the time until the bolus peak is reached; so higher
numbers mean later bolus arrival.
A CBF image, on the other hand, displays numbers
proportional to blood flow; so smaller numbers indicate
lower flow.
4. Filming color images

If a color hardcopy device is connected to the system,
color images can be printed via the filming task card.
It is recommended to send the color images from the
Viewing task card after having saved them on the Per-
fusion task card.
5. How to fine-tune the color mapping?

For flow images (CBF and CBV) the color palette
for the flow image is designed such, that after optimal
adjustment with the arrow buttons the following
approximate correspondence will result for a normal
brain:
red _ vessels
green/yellow _ gray matter
blue _ white matter
black _ no calculation (CSF space)
69
Perfusion CT
After adjustment (use non-ischemic hemisphere as

guideline) ischemic areas will therefore be displayed
either in violet (very low flow) or as a mismatch with
the nonischemic side (gray matter is blue instead of
green).
For Time images (Time to Start and Time to Peak)
the color palette for the time images maps increas-
ing time values on a spectral scale:
Violet _ blue _ green _ yellow _ red
Display should be adjusted with the arrow buttons
such that the areas with latest arrival times are just
slightly red. As with the flow image black means no
calculation (CSF space, or areas with extremely low
flow no time assessment possible).
70
Perfusion CT
71
Dynamic Scanning
Dynamic Scanning
These are protocols templates for the analysis of

contrast enhancement dynamics in the body. Scan
parameter details such as mAs, slice width, incre-
ment etc. depend on the organ to be studied.
These may be used with the Dynamic Evaluation
function for the descriptive analysis of contrast enhance-
ment of tissues.
Scan Protocols
There are two scan protocols available:

BodyDynCT, a Multiscan with a 3 mm slice collimation
and 6 times a 9 mm slice width.
BodyDynSingle, a Multiscan with a 5 mm slice
collimation and 2 times a 10 mm slice width.
72
Dynamic Scanning
BodyDynCT Multiscan
kV 110
Effective mAs 120
Slice width 9.0 mm
Feed/Scan 0 mm
Kernel B31s
BodyDynSingle Multiscan
kV 110
Effective mAs 120
Slice width 10.0 mm
Feed/Scan 0 mm
Kernel B31s
73
Interventional CT
Interventional CT
To facilitate CT interventional procedures, we created

dedicated multislice and single slice sequential modes.
Biopsy
This is the multislice biopsy mode. E. g. 6 slices,
3.0 mm each, will be reconstructed and displayed
for each scans.
Biopsy06s
This is the multislice biopsy mode, using 0.6 sec.
rotation time. E. g. 6 slices, 3.0 mm each,
will be reconstructed and displayed for each scans
(optional).
BiopsyCombine
This is a single slice biopsy mode. A scan with 5 mm
slice collimation and one time 10 mm slice thickness.
BiopsyCombine06s
This is a single slice biopsy mode, using 0.6 sec.
rotation time. A scan with 5 mm slice collimation and
one time 10 mm slice thickness (optional).
The Basics
Any of these protocols can be appended to a spiral

protocol for CT interventional procedures, such
as biopsy, abscess drainage, pain therapy, minimum
invasive operations, joint studies, and arthrograms.
10 scans are predefined. You can repeat it by clicking
the chronicle with the right mouse button and select
repeat, or simply change the number of scans to 99
before you start the first scan.
You can Append any routine protocol after the
interventional procedure for a final check and docu-
mentation, e. g. a short range of spiral scanning for
the biopsy region. The table height can be adjusted
to minimum 255 mm.
74
Interventional CT
How to do it
Biopsy
Indications: This is the multislice biopsy mode. 6 slices,
3.0 mm each, will be reconstructed and displayed for
each scans.
It can be appended to any other scan protocol, e. g.
ThoraxRoutine for biopsy procedures in the thorax.
Change the mAs setting accordingly before you load
the mode.
Biopsy
kV 130
Effective mAs 110
Slice width 6.0 mm
Feed/Scan 0 mm
Cycle time 1.6 sec.
Kernel B31s
Biopsy06s
Indications: This is the multislice biopsy mode, using
0.6 sec rotation time. 6 slices, 3.0 mm each, will be
reconstructed and displayed for each scans.
the mode.
Biopsy06s
kV 130
Effective mAs 110
Slice width 6.0 mm
Feed/Scan 0 mm
Cycle time 1.2 sec.
Kernel B31s
75
Interventional CT
1. Perform a spiral scan first to define a target slice.
2. Click Same TP under Table position in the routine
card, and move the table.
3. Turn on the light marker to localize the Entry point,
and then start the patient preparation.
4. Select Biopsy mode under Special protocols, and
then click Append.
5. Click Load and then Cancel move. Press the
Start button and 6 images will be displayed.
6. Press Start again, youll get another 6 images with
the same slice position.
BiopsyCombine
Indications: This is the biopsy mode with one combined
slices. It can be appended to any other scan protocol,
e. g. ThoraxRoutine for biopsy procedures in the thorax.
the mode.
BiopsyCombine
kV 130
Effective mAs 70
Slice width 10.0 mm
Feed/Scan 0 mm
Cycle time 1.6 sec.
Kernel B31s
76
Interventional CT
BiopsyCombine06s
Indications: This is the biopsy mode with one com-
bined slice, using 0.6 sec. rotation time.
the mode.
BiopsyCombine
kV 130
Effective mAs 110
Slice width 10.0 mm
Feed/Scan 0 mm
Cycle time 1.2 sec.
Kernel B31s
1. Perform a spiral scan first to define a target slice.
2. Click Same TP under Table position in the routine
card, and move the table.
3. Turn on the light marker to localize the Entry point,
and then start the patient preparation.
4. Select BiopsyCombine mode under Special proto-
cols, and then click Append.
5. Click Load and then Cancel move. Press the
Start button and one image will be displayed.
6. Press Repeat and Start again, youll get another
image with the same slice position.
77
Interventional CT
Information
In the BiopsyCombine mode, the slice position, table
position, table begin and table end are all the same.
In the Biopsy mode, the slice position, table position,
table begin and table end are different.
a) The SP (slice position) in each image means the

center of the image (Fig. 1).
Image 1 Image 2 Image 3 Image 4 Image 5 Image 6
SP SP SP SP SP SP
Fig. 1
b) The Table position means the central position

of the 6 images and will also be the position of the
positioning light marker (Fig. 2).
Table position
Fig. 2
c) The table Begin means the center of the first

image, and the table End means the center of the
last image (Fig. 3).
Table Begin Table End
Fig. 3
78
Interventional CT
79
Trauma
Trauma
In any trauma situation, time means life and the

quality of life for the survivor. In order to facilitate the
examinations, two protocols are provided:
PolyTrauma
This is a combined mode for examination of multiple
ranges, e. g. Head, Neck, Thorax and Abdomen.
PolyTrauma06s
This is a combined mode with 0.6 s rotation time
for the examination of multiple ranges, e. g. Head,
Neck, Thorax and Abdomen (optional).
The Basics
Check that the emergency drug trolley is well-stocked

and that all accessories such as in-room oxygen
supply, respirator and resuscitation equipment that
may be required during the examination are in work-
ing order.
Prepare the CT room before admitting the patient,
e. g., load IV contrast into the injector.
Know, observe and practice the standard hospital
operating policy for handling a patient in distress
e. g. Code Blue for cardiac and respiratory arrest.
Any possible injuries to the spinal column should be
determined before beginning the examination and
taken into account when shifting and positioning the
patient.
Ensure that all vital lines e. g., IV tubing and oxygen
tubing are not trapped under the patient or between
the table and the cradle. Make allowance for the
length of tubing required for the topogram scan range.
Never leave patients unattended at any time during
80
Trauma
the procedure.
Observe the vital signs e. g. ECG, respiration, etc. at
all times during the procedure.
Finish the examination in the shortest possible time.
How to do it
PolyTrauma and Poly Trauma06s

Scan Protocol
A scan range of head is 12 cm and will be done
in 11.3 s.
A typical scan range for the C-spine is 15 cm and will
be done in 14.5 s.
PolyTrauma Cerebrum C-spine

kV 130 130
Effective mAs 170 150
Slice collimation 3.0 mm 2.0 mm
Slice width 6.0 mm 2.5 mm
Feed/Rotation 21.6 mm 12.0 mm
Rotation time 1.5 sec. 1.0 sec.
Kernel H31s B50s
Increment 6.0 mm 1.5 mm
Image order cr-ca cr-ca
CTDIVol 37.7 mGy 17.0 mGy
81
Trauma
PolyTrauma
A scan range of thorax is 30 cm and will be done in 11.6 s.
A typical scan range of a abdomen with pelvis is 40 cm
and will be done in 13.5 s.
PolyTrauma Thorax Abdomen

kV 130 130
Effective mAs 50 95
Kernel B41s B41s
PolyTrauma06s
A scan range of thorax is 30 cm and will be done in 8.7 s.
A typical scan range of a abdomen with pelvis is 40 cm
and will be done in 10 s.
PolyTrauma06s Thorax Abdomen

kV 130 130
Effective mAs 50 95
Kernel B41s B41s
In different polytrauma cases,you could either com-

bine different protocols,or delete any of the chronicles
from the predefined protocol if they are not needed.
82
Trauma
Information
For long range scanning, please pay attention to the

mark of scannable range on the table mattress while
positioning the patient.
In some cases, it might be advisable to position the
patient feet first so that there will be more space for
the intensive care equipment around.
83
LungCARE
LungCARE
syngo LungCARE is a dedicated software for visuali-

zation and evaluation of pulmonary nodules using
lowdose lung scanning and for subsequent follow-up
studies.
Indications:
Lung studies with low dose setting, e. g. early visuali-
zation of pulmonary nodules.
A typical thorax study in a range of 30 cm will be
covered in 23.8 s.
LungCARE
kV 110
Effective mAs 15
Slice width 1.25 mm
Kernel B50s
Increment 0.8 mm
Image order cr-ca
CTDIVol 1.36 mGy
84
LungCARE
LungCARE06s
Indications:
Lung studies with low dose setting, e. g. early visuali-
zation of pulmonary nodules, using a rotation time 0.6 s
(optional).
A typical thorax study in a range of 30 cm will be
covered in 17.8 s.
LungCARE06s
kV 110
Effective mAs 15
Slice width 1.25 mm
Kernel B50s
Increment 0.8 mm
Image order cr-ca
CTDIVol 1.36 mGy
85
LungCARE
For further information on the syngo LungCARE

Application, please refer to the Application Guide
Clinical Options.
Fig. 1: User interface of syngo LungCARE
86
LungCARE
Functionalities
3D Visualization with Thin Slabs using MPR, MIP
and VRT displays.
Computer-guided localization of pre-marked lesion.
Close-up inspection of suspected lesion with the
Rotating MPR mode.
Automatic evaluation of pulmonary nodules with
perspective VRT or MPR display.
Automatic volume and diameter measurements of
pulmonary nodules.
Follow-up mode with synchronization of two data-
sets.
Easy and flexible reporting of the evaluated nodules.
87
Colonography
CT Colonography
This is a promising application, dedicated to visualize

and evaluate lesions in the colon. This study is not only
non-invasive, but a much more comfortable method
for the patient.
A typically range of 40 cm can be covered in 31.2 s.
CT Colonography 2nd reconstr.

kV 130
Effective mAs 90
Kernel B41s B41s
Image order cr-ca
CTDIVol 11.9 mGy
88
Colonography
CT Colonography06s
This is a promising application, dedicated to visualize

and evaluate lesions in the colon. This study is not only
non-invasive, but a much more comfortable method
for the patient, using a 0.6 s rotation time (optional).
A typically range of 40 cm can be covered in 27.8 s.
CT Colonography06s 2nd reconstr.

kV 130
Effective mAs 90
Scan time 27.9
Kernel B41s B41s
Image order cr-ca
CTDIVol 11.9 mGy
89
Colonography
Fig. 1: User interface of syngo Colonography
90
Colonography
A comprehensive study consists of four sections:

Preparation, examination in supine & prone positioning,
and postprocessing.
Patient preparation
Important for good results in a syngo Colonography
evaluation adequate preparation in bowel cleaning
must be done.
The patient has to start with a diet and bowel
cleansing two days prior to the examination like for
a conventional Colonoscopy.
Patient examination
The bowels can be delineated with air. Or, if desired,
with carbon dioxide.
Inflate the colon to the patients maximum tolerance.
To decrease colon spasm, e. g. Buscopan or
Glucagon can be given IV.
Usually, a prone and supine examination are done to
differentiate between polyps and stool within the
colon. The second scan can be performed with lower
dose, e. g. 30 to 50 mAs.
Postprocessing
For further information on the syngo Colonography
Application, please refer to the Application Guide
Clinical Options.
91
Appendix
Osteo CT
Example for one patient with three Osteo

tomograms:
PATIENT; John Smith; 007; 64; Male
IMAGE; L2; 234; 2; 27-JAN-1998; 11:12:17; 61.7;
48.9; 55.3; 20.8; 20.1; 21.5; 205.8; 192.0; 198.7;
50.6; 47.5; 49.5
IMAGE; L3; 236; 3; 27-JAN-1998; 11:12:18; 60.4;
54.5; 49.3; 22.3; 21.1; 21.8; 210.5; 191.9; 180.7;
50.4; 47.5; 52.3
IMAGE; L4; 238; 4; 27-JAN-1998; 11:12:18; 59.3;
43.1; 55.0; 20.6; 29.0; 23.3; 201.8; 178.1; 192.3;
43.6; 45.9; 44.2
REFDATA; 64; Male; 20; -4.35; -3.12; 75.4; 125.3; 26.5
Data Structure of the result file:

PATIENT; <Patient name>; <Patient ID>;
<Age of patient>; <Sex of patient>
IMAGE; <Vertebra name>; <Image number>;
<Scan number>; <Scan date>; <Scan time>; <TML>;
<TMR>; <TMT>; <TSL>; <TSR>; <TST>; <CML>; <CMR>;
<CMT>; <CSL>; <CSR>; <CST>
REFDATA; <Age of patient>; <Sex of patient>;
<Age of young normal>; <T-Score>; <Z-Score>;
<BMD reference data, age matched>;
<BMD reference data, young control>;
<Standard deviation reference data>
90
Appendix
Abbreviations:
TML Trabecular Mean Left
TMR Trabecular Mean Right
TMT Trabecular Mean Total
TSL Trabecular Standard Deviation Left
TSR Trabecular Standard Deviation Right
TST Trabecular Standard Deviation Total
CML Cortical Mean Left
CMR Cortical Mean Right
CMT Cortical Mean Total
CSL Cortical Standard Deviation Left
CSR Cortical Standard Deviation Right
CST Cortical Standard Deviation Total
91
Appendix
Pulmo CT
Example of result file:

START; 20-FEB-1998 12:01:17
PATIENT; John Smith; 007; 64; Male
IMAGE; 234; 21; 27-JAN-1998 11:12:17;-200;1
RESULTS; LEFT; 234; -1024; 3071; -905; 43.4; 22.5;
112; 34.5; 0.1
RESULTS; RIGHT; 234; -1024; 3071; -899; 33.4; 19.5;
85; 30.1; 0.1
RESULTS; TOTAL; 234; -1024; 3071; -903; 38.1; 21.0;
93; 64.6; 0.1
SUBRANGE; LEFT; 234; 1; -1000; -400; 200; 75.0;
15.9; 3.3
SUBRANGE; RIGHT; 234; 1; -1000; -400; 200; 80.9;
15.1; 2.2
SUBRANGE; TOTAL; 234; 1; -1000; -400; 200; 78.0;
15.5; 2.8
SUBRANGE; LEFT; 234; 2; -1024; 1000; 0; 100.0
SUBRANGE; RIGHT; 234; 2; -1024; 1000; 0; 100.0
SUBRANGE; TOTAL; 234; 2; -1024; 1000; 0; 100.0
PERCENTILE; LEFT; 234; 1; 0; 100; 25; -1012; -954;
-953; -885; -884; -800; -799; -112
PERCENTILE; RIGHT; 234; 1; 0; 100; 25; -1023; -934;
-933; -888; -887; -785; -784; -211
PERCENTILE; TOTAL; 234; 1; 0; 100; 25; -1023; -944;
-943; -886; -885; -793; -793; -112
92
Appendix
Data structure of the result file:

START; <Date and Time of the evaluation start>
PATIENT; <Patient name>; <Patient ID>;
<Age of patient>;
<Sex of patient>
IMAGE; <Image number>; <Scan number>;
<Scan date and time>; <Threshold Contour>;
<Number of Shrinkings>
RESULTS; <LEFT/RIGHT/TOTAL>; <Image number>;
<Lower eval. limit>; <Upper eval. limit>; <Mean>;
<Standard Deviation>; <Area>; <FWHM>;
<Accumulated Volume>; <Accumulated Height>
SUBRANGE; <LEFT/RIGHT/TOTAL>; <Image number>;
<Subrange Number>; <Lower Limit>; <Upper Limit>;
<Increment>; <Percent Area first subrange>; .....;
<Percent Area last subrange>
PERCENTILE; <LEFT/RIGHT/TOTAL>;
<Image number>; <Percentile range number>;
<Lower Limit>; <Upper Limit>; <Increment>;
<Lower HU value first percentile>;
<Upper HU value first percentile>; .....;
<Lower HU value last percentile>;
<Upper HU value last percentile>
AUTOSEGMENT; <LEFT/RIGH >;
<Image number>; <Segmentation number>;
<W=Whole/C=Central/P=Peripheral>;
<A=Area/H=Heights>; <Number of segments>;
<Distance>; <ROI width>;
<AP gradient : 0=no / 1=yes>;
<Mean value first segment>; ....;
<Mean value last segment>;
<Standard deviation first segment>; ....;
<Standard deviation last segment>;
<Area first segment>; ....; <Area last segment>;
<AP-Gradient>
93
Appendix
MANSEGMENT; <LEFT/RIGHT>;
<Image number>; <Segmentation number, always 1>;
<Number of segments>;
<Mean value first segment>; ....;
<Mean value last segment>;
<Standard deviation first segment>; ....;
<Standard deviation last segment>;
<Area first segment>; ....; <Area last segment>
TOTALRESULTS; <LEFT/RIGHT/TOTAL>;
<Upper eval. limit>; <Lower eval. limit>; <Mean>;
<Standard Deviation>; <Area>; <FWHM>;
<Accumulated Volume>; <Accumulated Height>
TOTALSUBRANGE; <PATIENT/REFERENCE/RATIO>;
<Subrange Number>; <Lower Limit>; <Upper Limit>;
<Increment>;
<Percent Area first subrange (or Ratio for RATIO)>; .....;
<Percent Area last subrange (or Ratio for RATIO)>
TOTALPERCENTILE;
<PATIENT/REFERENCE/DIFFERENCE>;
<Percentile range number>;
<Lower Limit>; <Upper Limit>; <Increment>;
<Lower HU value first percentile
(or difference for DIFFERENCE)>;
<Upper HU value first percentile
(or difference for DIFFERENCE)>; .....;
<Lower HU value last percentile
(or difference for DIFFERENCE)>;
<Upper HU value last percentile
(or difference for DIFFERENCE)>
REFDATA; <Age of patient>; <Sex of patient>;
<Age of young normal>; <T-Score>;
<Z-Score>; <Reference data, age matched>;
<Reference data, young control>;
<Standard deviation reference data>
END; <Date and Time of the evaluation end>
94
Appendix
95
Siemens reserves the right to modify
the design and specifications contained
herein without prior notice. Please
contact your local Siemens Sales
Representative for the most current
information.
Original images always loose a certain

amount of detail when reproduced.
Siemens AG
Medical Solutions
Computed Tomography
Siemensstrasse 1 Order No.
D-91301 Forchheim A91100-M2100-2228-1-7600
Germany Printed in Germany
www.SiemensMedical.com BKW 42228 BA 05033.

Somatom Emotion 6 Special

Enviado por

Dados do documento

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

Somatom Emotion 6 Special

Enviado por

Direitos autorais:

Formatos disponíveis

SOMATOM Emotion 6

HeartView CT is a clinical application package specifi-

Important Anatomical Structures of the Heart

Fig. 4: Front view Fig. 5: Conventional

SVC: Superior Vena Cava

Left coronary artery (LCA)

Fig. 6: Front view Fig. 7: Conventional

LM: Left Main Artery

Cardiac Cycle and ECG

Ventricular contraction Ventricular

To minimize motion artifacts in cardiac images, two

Absolute delay: a fixed time delay after the onset of

Absolute reverse: a fixed time delay prior to the

Prospective ECG-Triggering Versus Retrospective

Europe Version (IEC standard)

Preview Series Reconstruction

Example of a preview series at the correct anatomical

Fig. 14: Dose modulation with ECG pulsing.

ACV-Reconstruction with 0.6 sec. rotation time

Fig. 15: Temporal resolution as a function of the

The two kernels B35s and B46s are especially

* Depends on heart rate.

If you apply API for image acquisition, please make

If you apply API for image acquisition, please make

* Depends on heart rate.

Aortic-, Pulmonary- and High resoulution Studies

* Depends on heart rate.

You can activate the Auto load in 3D function on the

Calcium Scoring evaluation is performed on a separate

User interface of syngo Calcium Scoring

The administration of intravenous (IV) contrast

The dynamics of the contrast enhancement is

Aortic time-enhancement curves after i.v. contrast

Relative Enhancement [HU]

Fig. 2a: 2 ml/s, Fig. 2b: 4 ml/s,

Relative Enhancement [HU]

Fig. 3a: 80 ml, Fig. 3b:120 ml,

Relative Enhancement [HU]

Fig. 4a: Uni-phase Fig. 4b: Bi-phase

To achieve optimal results in contrast studies, the use

This is an automatic bolus tracking program, which

After the Topogram is performed, the predefined

5. If API is used in conjunction with CARE Bolus, the

This is an application package for reformatting pano-

What is the relevant anatomical information for oral

What can Dental CT do?

It is mandatory to position the patient head in the

Fig. 3: User interface of syngo Dental

Multiple paraxial ranges can be defined on one

This is an application package for the quantitative

This program enables the quantitative determination

Siemens Reference Data:

The special kernels are mostly used for physical

Fractured vertebrae are not suited for Osteo CT

Fig. 3: Filming layout

Note: it is not recommended to use filming setting

This is an application package, which serves for

No specific scan protocols were set up for this option.

Full Inspiration Full Expiration

Density = @ Density = >2 x @

Fig. 1: Lung density at full inspiration/expiration

Examinations should be acquired always at the same

Siemens Reference Data

User-Specific Reference Data